Which States Regulate Chiropractic Assistants

Whether a chiropractic assistant needs a state credential depends entirely on the state. A handful of chiropractic boards license, certify or register assistants: among the states we have verified, New Jersey licenses them, Nevada certifies them, Arizona and Florida register them, and Alaska requires a named clinical assistant certification within a year of hire. Others issue no credential but write rules on training and supervision that the DC must follow, as Colorado, New Mexico, Montana and Nebraska do. And several boards, including Alabama's, California's, Connecticut's and Delaware's, report to the Federation of Chiropractic Licensing Boards (FCLB) that they do not regulate assistants at all. FCLB's own count is that twelve regulatory boards in the United States have statutory authority over chiropractic assistants.

For a clinic owner, the difference is who files what. Where the state credentials the assistant, an unregistered assistant performing regulated tasks is a problem for both the assistant and the supervising DC. Where it does not, the DC carries the training and supervision record.

Which states license, certify or register assistants?

• New Jersey licenses chiropractic assistants (L.C.A.). The board licenses an assistant after board-recognized education and clinical training and a board-approved competency exam (N.J.A.C. 13:44E-4.3 and 4.4). L.C.A.s work under on-premises DC supervision and may not adjust, perform manual therapy or give nutritional instruction.
• Nevada certifies chiropractic assistants under NRS and NAC chapter 634. Applicants pass a board exam and submit fingerprints; certificates renew in even-numbered years with 12 CE hours, and a temporary certificate exists for an assistant credentialed in another state. Nevada's dry needling rule also bars chiropractic assistants from dry needling.
• Arizona registers chiropractic assistants (C.A.) under Ariz. Admin. Code R4-7-1102. The DC notifies the board within seven days of hiring. The assistant completes 24 hours of board-approved coursework within a year, more if the DC holds physiotherapy or acupuncture certification, and registers for each workplace and supervising DC.
• Florida has two credentials under chapter 460, Florida Statutes. A registered chiropractic assistant is registered by the board to perform chiropractic services under the direct supervision of a chiropractic physician or a certified chiropractic physician's assistant (section 460.403). A certified chiropractic physician's assistant (section 460.4165) is a more senior credential: the applicant must be at least 18 and a graduate of a board-approved program of at least 200 didactic classroom hours or the equivalent, and the board interviews both the applicant and the proposed supervising DC about the work arrangement.
• Alaska requires clinical assistants to hold FCLB's CCCA, the Tennessee Chiropractic Association's CTA program or a board-recognized equivalent within 12 months of hire, plus current CPR (12 AAC 16.052). Clinical assistants may not adjust, diagnose or change treatment plans. More on that credential in our post on FCLB's CCCA.

Which states set rules without a credential?

In these states there is nothing to file for the assistant, but the rules put conditions on the DC:

• Colorado (3 CCR 707-1, Rule 1.18). Assistants are unlicensed, and the supervising DC must confirm and document their training. Staff who take x-rays need a board-approved 24-hour radiography course first.
• New Mexico (16.4.19.8 NMAC). No assistant license, but minimums: high school or equivalent plus three months of supervised training, with the DC personally training the assistant and physically present in the building during treatment.
• Montana (Mont. Admin. R. 24.126.516). No assistant license. A DC may delegate chiropractic physiotherapy to an auxiliary assistant while on the premises and supervising, and keeps full responsibility.
• Nebraska (172 NAC 29-004). No assistant credential. Unlicensed persons may perform non-complex, assigned tasks under direct or indirect supervision, including written protocols, and the DC stays accountable.
• Arkansas. The board's applicant information describes chiropractic aides as unlicensed, working under direct supervision, and barred from diagnosing, adjusting or mobilizing the spine. An aide who takes x-rays needs a state radiologic technology license or ACRRT certification.

Which states do not regulate assistants?

Alabama, California, Connecticut and Delaware each report to FCLB, in its board directory, that they do not regulate chiropractic assistants. That is self-reported board information, which we read through archived copies of FCLB's directory, so treat it as a starting point. Even in an unregulated state, other laws still reach assistant work, most often the state's radiologic technology law for anyone who takes x-rays (see x-ray rules).

How should I handle assistants when I open in a new state?

1. Check the new state's rule before you transfer staff. An assistant registered in Arizona or certified in Nevada holds nothing in New Jersey, and a New Jersey L.C.A. holds nothing in Florida.
2. Watch the deadlines that run from hire. Arizona's seven-day notice and Alaska's 12-month certification window both start the day the assistant starts, not the day you remember to file.
3. Tie each registration to the right supervisor and site. Arizona registers the assistant for each workplace and supervising DC, and Florida's physician's assistant certification depends on an approved work arrangement. A new location or a new supervising DC can mean a new filing.
4. Document training where no credential exists. Colorado and New Mexico put the training record on the DC. Keep it in the personnel file.
5. Separate radiography from everything else. An assistant credential rarely covers x-rays.

How do assistant rules show up on our state pages?

Each state page under chiropractic licenses by state has an assistants line with the credential name and citation where we have verified one, and says so where we have not. If you are planning a multi-state group, read that line for every state on your list early; assistant rules affect staffing models more than most DC licensing differences do. See also running a practice in more than one state.

Our Chiropractic Assistant Registration service is $99 per assistant and covers the state filing, the training documents the board wants and the deadlines that run from hire. Board fees are extra, and the board decides each application.